DEPRESSION: WHAT YOU KNOW CAN HELP YOU

DEPRESSION: DEPRESSION: WHAT YOU KNOW CAN WHAT YOU KNOW CAN

HELP YOUHELP YOU

DEPRESSION: DEPRESSION: WHAT YOU KNOW WHAT YOU KNOW

CAN HELP YOUCAN HELP YOUINTERNATIONAL INTERNATIONAL

PERSPECTIVES FOR PERSPECTIVES FOR PEOPLE LIVING WITH PEOPLE LIVING WITH

DEPRESSIONDEPRESSIONAND THEIR FAMILIESAND THEIR FAMILIES

An International Mental Health An International Mental Health Awareness Packet from the World Awareness Packet from the World

Federation for Mental HealthFederation for Mental Health

This international awareness packet was supported by an unrestricted educational grant from WYETH Pharmaceuticals which had no control over its content

CONTENTSCONTENTS IntroductionIntroduction What is Depression?What is Depression? Diagnosing DepressionDiagnosing Depression Treating DepressionTreating Depression Living with DepressionLiving with Depression Helping Someone You Know with DepressionHelping Someone You Know with Depression The Effects of Stigma and Discrimination on The Effects of Stigma and Discrimination on

People with DepressionPeople with Depression Depression and its Co-TravelersDepression and its Co-Travelers Regional Perspectives on Depression: Regional Perspectives on Depression:

Snapshots from Australia, Brazil, Canada, Snapshots from Australia, Brazil, Canada, MexicoMexico

Depression Information Resources, by Depression Information Resources, by CountryCountry

ReferencesReferences

INTRODUCTIONINTRODUCTION

DEPRESSION ISDEPRESSION IS One of the leading causes of disability One of the leading causes of disability

across the worldacross the world A disorder of the brainA disorder of the brain Responsive to early diagnosis and Responsive to early diagnosis and

effective treatmenteffective treatment A health condition that is still A health condition that is still

frequently misunderstood and the frequently misunderstood and the subject of stigmasubject of stigma

WHAT IS DEPRESSION?WHAT IS DEPRESSION?

Depression FactsDepression Facts Depression affects people of all ages, races, Depression affects people of all ages, races,

religions and income levels worldwidereligions and income levels worldwide Depression is not a sign of weakness or a Depression is not a sign of weakness or a

defect in characterdefect in character People with Depression cannot get better People with Depression cannot get better

simply by “pulling themselves up by their simply by “pulling themselves up by their bootstraps”bootstraps”

Depression is as real as other medical Depression is as real as other medical conditions such as cancer and diabetes and conditions such as cancer and diabetes and can and should be treatedcan and should be treated

TYPES OF DEPRESSIONTYPES OF DEPRESSION

Clinically, there are three primary types of Clinically, there are three primary types of depression, each with very specific depression, each with very specific diagnostic criteria:diagnostic criteria:

Major DepressionMajor Depression, also known as , also known as “Unipolar Depression”“Unipolar Depression”

Minor DepressionMinor Depression,, often known as often known as “Dysthymia”, a less severe but often chronic “Dysthymia”, a less severe but often chronic conditioncondition

Bipolar DisoderBipolar Disoder, also known as Manic , also known as Manic Depression, where periods of depression Depression, where periods of depression cycle with periods of maniacycle with periods of mania

DEPRESSION, WORLDWIDEDEPRESSION, WORLDWIDE

Symptoms of Depression can be identified in Symptoms of Depression can be identified in allall

cultures – some common risk factors forcultures – some common risk factors fordepression include:depression include: Gender (more common in women than in Gender (more common in women than in

men)men) Economic disadvantage (poverty)Economic disadvantage (poverty) Social disadvantageSocial disadvantage GeneticsGenetics Exposure to violenceExposure to violence Separation or divorceSeparation or divorce Other chronic illnessOther chronic illness

A Note on Risk FactorsA Note on Risk Factors

Having Depression is a risk factor for Having Depression is a risk factor for a number of other disorders, a number of other disorders,

including substance abuse, anxiety including substance abuse, anxiety disorders, heart disease, stroke, disorders, heart disease, stroke,

HIV/AIDS, and diabetes.HIV/AIDS, and diabetes.

Depression is a significant risk Depression is a significant risk factor for suicide.factor for suicide.

SUMMARYSUMMARY

WHAT YOU KNOW CAN HELP YOU!WHAT YOU KNOW CAN HELP YOU!Depression is a serious illness that Depression is a serious illness that affects the mind, brain and body. It affects the mind, brain and body. It can affect anyone regardless of age, can affect anyone regardless of age, ethnic background, socio-economic ethnic background, socio-economic

status, or gender. The causes of status, or gender. The causes of Depression are thought to be a Depression are thought to be a

combination of genetics, biology, and combination of genetics, biology, and emotional factorsemotional factors

DIAGNOSING DEPRESSIONDIAGNOSING DEPRESSION

Signs and SymptomsSigns and Symptoms Persistent sad, anxious or "empty" moodPersistent sad, anxious or "empty" mood Feelings of hopelessness, pessimismFeelings of hopelessness, pessimism Feelings of guilt, worthlessness, helplessnessFeelings of guilt, worthlessness, helplessness Loss of interest or pleasure in hobbies or Loss of interest or pleasure in hobbies or

activities that were once enjoyed, including activities that were once enjoyed, including sexsex

Decreased energy, fatigue, feeling “slowed Decreased energy, fatigue, feeling “slowed down”down”

Difficulty concentrating, remembering, Difficulty concentrating, remembering, making decisionsmaking decisions


Signs and SymptomsSigns and Symptoms Changes in sleep patterns: insomnia, Changes in sleep patterns: insomnia,

early morning waking or oversleepingearly morning waking or oversleeping Appetite and weight changesAppetite and weight changes Thoughts of death or suicide, or suicide Thoughts of death or suicide, or suicide

attemptsattempts Restlessness, irritabilityRestlessness, irritability Persistent physical symptoms that do not Persistent physical symptoms that do not

respond to treatment, such as headaches, respond to treatment, such as headaches, digestive disorders or chronic paindigestive disorders or chronic pain


DIAGNOSISDIAGNOSIS

International Classification of Diseases (ICD) 10: Depressive International Classification of Diseases (ICD) 10: Depressive EpisodeEpisode

In typical mild, moderate, or severe depressive episodes, the In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called circumstances and may be accompanied by so-called ‘‘somatic’’ symptoms, such as loss of interest and ‘‘somatic’’ symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number weight loss, and loss of libido. Depending upon the number and severity of the symptoms, a depressive episode may be and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe. specified as mild, moderate or severe.

Source: ICD-10, World Health Organization, 2005.Source: ICD-10, World Health Organization, 2005.

SUMMARYSUMMARY

What You Know Can Help YouWhat You Know Can Help YouDepression is real. There are many Depression is real. There are many signs and symptoms of depression, signs and symptoms of depression,

and each person with the disorder will and each person with the disorder will have a different experience. Getting have a different experience. Getting

a diagnosis of depression may be a diagnosis of depression may be difficult, depending upon where you difficult, depending upon where you live, but it is important. Utilize all of live, but it is important. Utilize all of

the the ResourcesResources in your community and in your community and refer to those included in this packetrefer to those included in this packet. .

TREATING DEPRESSIONTREATING DEPRESSION

There is no cure for Depression, but it There is no cure for Depression, but it can becan be

effectively diagnosed and treated. Someeffectively diagnosed and treated. Somecurrent methods of treating Depression current methods of treating Depression

are:are: MedicationsMedications PsychotherapyPsychotherapy Traditional or Alternative Healing Traditional or Alternative Healing

MethodsMethods Herbal RemediesHerbal Remedies Brain Stimulation TherapiesBrain Stimulation Therapies

TREATMENT RESEARCHTREATMENT RESEARCH

There are many existing treatments for There are many existing treatments for depression, and many have proven to be depression, and many have proven to be effective. There are still patients, however, effective. There are still patients, however, who do not get better even with treatment; who do not get better even with treatment; and others who have difficulty with the side and others who have difficulty with the side effects or risks involved in some of the effects or risks involved in some of the treatments. Researchers are continuing to treatments. Researchers are continuing to seek better and safer treatments for seek better and safer treatments for depression.depression.

Improved understanding of the brain, and how Improved understanding of the brain, and how it works is leading to new possibilities for it works is leading to new possibilities for treatment, and specifically new areas to target treatment, and specifically new areas to target in developing new medications. Scientists are in developing new medications. Scientists are looking at the role that genes play in looking at the role that genes play in influencing the way a patient responds to influencing the way a patient responds to treatment. Researchers are also seeking treatment. Researchers are also seeking treatments that work more quickly to reduce treatments that work more quickly to reduce the symptoms of depression, particularly the symptoms of depression, particularly severe and treatment resistant depression.severe and treatment resistant depression.

ADHERENCE TO TREATMENT: ADHERENCE TO TREATMENT: PERSONAL, SOCIAL AND PERSONAL, SOCIAL AND CULTURAL INFLUENCESCULTURAL INFLUENCES

There are often many There are often many barriersbarriers to getting to getting treatment for depression. Sometimes, they treatment for depression. Sometimes, they are related to your personal or community are related to your personal or community resources. Sometimes, they may be resources. Sometimes, they may be related to stigma or fear that people will related to stigma or fear that people will judge you. Other times, however, it may be judge you. Other times, however, it may be the depression itself that is a barrier. the depression itself that is a barrier. Some of the symptoms you are Some of the symptoms you are experiencing may impede your ability to experiencing may impede your ability to get the treatment you need. For example, get the treatment you need. For example, you may feel too exhausted or you may feel too exhausted or overwhelmed to seek treatment. Or you overwhelmed to seek treatment. Or you may feel hopeless and sure that nothing may feel hopeless and sure that nothing will help.will help.

SUMMARYSUMMARY

What You Know Can Help You!What You Know Can Help You!There are many effective treatments There are many effective treatments for depression. Most people with for depression. Most people with depression can get better with depression can get better with treatment. However, there are many treatment. However, there are many barriers to accessing treatments barriers to accessing treatments around the world. These barriers around the world. These barriers can be a result of the illness, or your can be a result of the illness, or your feelings about your illness, as well as feelings about your illness, as well as social and cultural influences. It social and cultural influences. It may be very challenging, but it is may be very challenging, but it is important to try to break down these important to try to break down these barriers to get the treatment you barriers to get the treatment you need.need.

LIVING WITH DEPRESSIONLIVING WITH DEPRESSION

Taking Care of YourselfTaking Care of Yourself Seeking SupportSeeking Support

- Friends and Family- Friends and Family

- Peer Support Groups- Peer Support Groups

- Mental Health - Mental Health OrganizationsOrganizations

RecoveryRecovery

What You Know Can Help You!What You Know Can Help You!Living with depression can be Living with depression can be difficult. You will need a lot of difficult. You will need a lot of support to maintain a healthy support to maintain a healthy lifestyle and stick to your treatment. lifestyle and stick to your treatment. Family members and close friends Family members and close friends can play critical roles in your can play critical roles in your treatment plan. Peer support groups treatment plan. Peer support groups and mental health organizations may and mental health organizations may also be sources of support for coping also be sources of support for coping with depression. There is a growing with depression. There is a growing emphasis on a recovery model across emphasis on a recovery model across the world that involves empowering the world that involves empowering people with mental illness to take people with mental illness to take charge of their own illness, their charge of their own illness, their treatment and their lives.treatment and their lives.

SUMMARYSUMMARY

HELPING SOMEONE YOU HELPING SOMEONE YOU KNOW WITH DEPRESSIONKNOW WITH DEPRESSION

What You May be Able to do to HelpWhat You May be Able to do to Help Talking and ListeningTalking and Listening Understanding DepressionUnderstanding Depression Supporting Their TreatmentSupporting Their Treatment Helping to Navigate the Healthcare Helping to Navigate the Healthcare SystemSystem Helping with Day-to-Day Living TasksHelping with Day-to-Day Living Tasks Helping to Care for ChildrenHelping to Care for Children Supporting Regular ActivitiesSupporting Regular Activities

HELPING SOMEONE YOU HELPING SOMEONE YOU KNOW WITH DEPRESSIONKNOW WITH DEPRESSION

Taking Care of YourselfTaking Care of Yourself

Tips for carers of people with Tips for carers of people with DepressionDepression Learn about DepressionLearn about Depression Put yourself “first” sometimesPut yourself “first” sometimes Take “time out”Take “time out” Talk to someone about your own Talk to someone about your own feelingsfeelings

SUMMARYSUMMARY

What You Know Can Help YouWhat You Know Can Help YouIf you know someone with depression, If you know someone with depression, there are many ways, both small and there are many ways, both small and complex, that you can help support complex, that you can help support

them in their recovery. These include them in their recovery. These include listening to their feelings, supporting listening to their feelings, supporting their treatment, maintaining regular their treatment, maintaining regular activities and helping them with the activities and helping them with the

simple and complex tasks of life. It is simple and complex tasks of life. It is important for you, as a carer and important for you, as a carer and

support person, to take good care of support person, to take good care of yourself as well.yourself as well.

THE EFFECTS OF STIGMA AND THE EFFECTS OF STIGMA AND DISCRIMIMATION ON PEOPLE DISCRIMIMATION ON PEOPLE

WITH DEPRESSIONWITH DEPRESSION Recognize that most mental illnesses are disorders Recognize that most mental illnesses are disorders

of the brain. of the brain. Be respectful of people with mental illness. Be respectful of people with mental illness. Don’t use disrespectful terms in referring to Don’t use disrespectful terms in referring to

people with a mental illness, such as retarded, people with a mental illness, such as retarded, crazy, nuts, or lunatic. crazy, nuts, or lunatic.

Refer to a person not just their illness, such as a Refer to a person not just their illness, such as a “person who has schizophrenia” instead of a “person who has schizophrenia” instead of a “schizophrenic”. “schizophrenic”.

Emphasize a person’s abilities and strengths Emphasize a person’s abilities and strengths rather than their disability or limitations. rather than their disability or limitations.

Help dispel myths about mental illness. Help dispel myths about mental illness. Promote greater awareness of mental illness. Promote greater awareness of mental illness. ••Encourage people to seek help for mental health Encourage people to seek help for mental health

problemsproblems..

SUMMARYSUMMARY

What You Know Can Help YouWhat You Know Can Help You

People with depression can face People with depression can face stigma and discrimination as a stigma and discrimination as a

result of their illness. Education result of their illness. Education and awareness about mental illness and awareness about mental illness and depression as real disorders of and depression as real disorders of the brain can help combat some of the brain can help combat some of

the myths and misconceptions the myths and misconceptions across the world.across the world.

DEPRESSION AND ITS CO-DEPRESSION AND ITS CO-TRAVELLERSTRAVELLERS

Depression can co-exist with other illnesses, and Depression can co-exist with other illnesses, and can be responsible for a significant proportion of can be responsible for a significant proportion of disability associated with these conditionsdisability associated with these conditions

Understanding the Understanding the mind-body connectionmind-body connection when looking at the co-occurrence of depression when looking at the co-occurrence of depression with other disorders is an important area of with other disorders is an important area of research. research.

We know that the risk of depression increases We know that the risk of depression increases with other neurological disorders, such as with other neurological disorders, such as Parkinson’s disease, stroke, and multiple Parkinson’s disease, stroke, and multiple sclerosis sclerosis

Having diabetes doubles the risk of depression Having diabetes doubles the risk of depression


Untreated depression alongside diabetes can Untreated depression alongside diabetes can increase the risk for diabetes-related increase the risk for diabetes-related complications, such as heart disease, blindness, complications, such as heart disease, blindness, amputations, stroke, and kidney disease. amputations, stroke, and kidney disease.

Depression is associated with a a 1.5- to 2-fold Depression is associated with a a 1.5- to 2-fold increased risk of cardiovascular disease, increased risk of cardiovascular disease, independent of other known risk factors, and is independent of other known risk factors, and is itself linked directly or indirectly to risk factors itself linked directly or indirectly to risk factors such as smoking and obesity such as smoking and obesity

People with depression are much less likely to People with depression are much less likely to follow medical recommendations for treating follow medical recommendations for treating their depression or other illness, such as diabetes their depression or other illness, such as diabetes and heart disease and heart disease


Research has also shown that depression also co-Research has also shown that depression also co-occurs with other mental illnesses, such as occurs with other mental illnesses, such as anxiety disordersanxiety disorders, which include post-traumatic stress , which include post-traumatic stress disorder (PTSD), obsessive compulsive disorder, panic disorder (PTSD), obsessive compulsive disorder, panic disorder, social phobia and generalised anxiety disorder, social phobia and generalised anxiety disorders disorders

Alcohol and substance abuse frequently co-occur with Alcohol and substance abuse frequently co-occur with depression. There are mixed reports from researchers depression. There are mixed reports from researchers whether this use is a symptom of the disorder, or a co-whether this use is a symptom of the disorder, or a co-occurring condition. Alcohol and substance abuse can occurring condition. Alcohol and substance abuse can often make it hard to detect an underlying case of often make it hard to detect an underlying case of depression.depression.

Depression is associated with increased mortality, Depression is associated with increased mortality, particularly through suicide. Research has shown particularly through suicide. Research has shown that 90 percent of the people who kill themselves have that 90 percent of the people who kill themselves have depression or another diagnosable mental or depression or another diagnosable mental or substance abuse disorder substance abuse disorder

SUMMARYSUMMARY

What You Know Can Help YouWhat You Know Can Help YouDepression co-occurs with many other Depression co-occurs with many other illnesses and diseases, including heart illnesses and diseases, including heart disease, diabetes, cancer, Parkinson’s disease, diabetes, cancer, Parkinson’s disease, as well as other mental and disease, as well as other mental and substance use disorders. If you have substance use disorders. If you have

another illness in addition to another illness in addition to depression, it is important to treat depression, it is important to treat

your symptoms of depression, as well your symptoms of depression, as well as adhering to your treatment plan for as adhering to your treatment plan for

any other co-occuring illness. any other co-occuring illness. Depession is a significant risk factor Depession is a significant risk factor

for suicide. Knowing the warning signs for suicide. Knowing the warning signs for suicide can help to protect you. for suicide can help to protect you.

REGIONAL PERSPECTIVES ON REGIONAL PERSPECTIVES ON DEPRESSIONDEPRESSION

AUSTRALIAAUSTRALIA BRAZILBRAZIL CANADA CANADA MEXICOMEXICO

(INDIVIDUAL FACT SHEETS IN THE ACCOMPANYING(INDIVIDUAL FACT SHEETS IN THE ACCOMPANYING

AWARENESS PACKET PROVIDE SNAPSHOTS ABOUTAWARENESS PACKET PROVIDE SNAPSHOTS ABOUT

DEPRESSION IN THESE COUNTRIES)DEPRESSION IN THESE COUNTRIES)

DEPRESSION: WHAT YOU KNOW DEPRESSION: WHAT YOU KNOW CAN HELP YOUCAN HELP YOU

An International Awareness An International Awareness Packet from the World Federation Packet from the World Federation

for Mental Healthfor Mental Health©World Federation for Mental Health (2010)The materials in this mental health awareness packet may be reproduced for use in non-commercial mental health education and awareness activities, including use as handouts at workshops, support groups, and other meetings. Materials contained on the CD-Rom include translations in Spanish and Portuguese. Permission to translate the materials without change or adaptation of text, in whole or part, may be requested by contacting the World Federation for Mental Health. These materials can also be accessed and downloaded from the WFMH website at www.wfmh.org.

This international mental health awareness packet was supported by an unrestricted educational grant from WYETH Pharmaceuticals which had no control over its content.

THE WORLD FEDERATION FOR THE WORLD FEDERATION FOR MENTAL HEALTHMENTAL HEALTH

12940 Harbor Drive, Suite 10112940 Harbor Drive, Suite 101Woodbridge VA 22192 USAWoodbridge VA 22192 USA

+1-703-494-6515+1-703-494-6515+1-703-494-6518 (Fax)+1-703-494-6518 (Fax)[email protected]@wfmh.comwww.wfmh.orgwww.wfmh.org

“Making Mental Health a Global Priority”“Making Mental Health a Global Priority”

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DEPRESSION: WHAT YOU KNOW CAN HELP YOU